JP2012024126A - Blood purification apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a blood purification apparatus enabling an operator to macroscopically inspect whether blood has coagulated in a mesh of a vein chamber by stopping a blood pump when a venous pressure increased, reversely filtering almost the same amount of dialysate as the volume from a blood purifier to the vein chamber and replacing the blood in the vein chamber by the dialysate.SOLUTION: The blood purification apparatus includes: a blood purifier 1; a blood circuit 2; a blood pump 3 provided on an artery side blood circuit 21; a vein chamber 23 provided on a vein side blood circuit 22; and a dialysate circuit 4. A viscous chamber 5 is provided on the dialysate circuit 4 so that hermetically sealing water-removal control can be executed. The viscous chamber 5 is equipped with a viscous pump 61, and is configured so that reverse filtration can be executed by controlling drive and stop of the viscous pump 61 having functions of a reverse filtration pump as a constituent of the reverse filtration device 6 by a reverse filtration pump control means 62.

Description

  The present invention relates to a blood purification apparatus in which, when blood coagulation occurs in a mesh of a vein chamber during blood purification treatment, the blood coagulation can be easily confirmed visually.

When the venous chamber internal pressure increases, it is important to know whether the tip of the venous puncture needle has adhered to the tube wall of the shunt or whether blood has clotted with the venous chamber mesh.
If blood clots in the venous chamber mesh, the blood circuit must be replaced as soon as possible. If the blood circuit is left as it is, the blood coagulates even in the dialyzer and the blood circulating outside the body cannot be returned to the body, and the blood must be discarded together with the blood circuit and the dialyzer.

  Therefore, various studies have been made on the shape and structure of a venous chamber that suppresses blood coagulation (Patent Documents 1 and 2). However, once blood coagulation has occurred, the above-described problems have occurred.

At present, in order to know whether the tip of the venous puncture needle has adhered to the tube wall of the shunt or blood clotted by the mesh of the venous chamber, the internal pressure of the venous chamber decreases by moving the tip of the venous puncture needle in various ways. It is common to check whether or not. If the pressure in the venous chamber decreases, it can be determined that the tip of the venous puncture needle has adhered to the tube wall of the shunt. However, even if the tip of the venous puncture needle is moved in various ways and the internal pressure of the venous chamber does not decrease, this finding does not indicate that the tip of the venous puncture needle is stuck to the tube wall of the shunt. It cannot be determined that is solidified. In many cases, the tip of the venipuncture needle attached to the shunt tube wall cannot be released from the shunt tube wall. In addition, if the cause of the increase in the venous chamber internal pressure is blood coagulation generated in the mesh of the venous chamber, blood coagulation also starts in the dialyzer while moving the tip of the venous puncture needle, Along with the dialyzer and blood circuit, blood circulating outside the body may have to be discarded.

In order to know the cause of the increase in the venous chamber internal pressure, about 200 ml of the return electrolyte solution is injected into the blood circuit, so that the blood in the venous chamber is replaced with the electrolyte solution, and the blood coagulates with the mesh in the venous chamber. There is another way to visually check if it is not. However, this method requires a complicated operation, and there is a disadvantage that the electrolyte solution for returning blood is insufficient. In addition, after stopping the blood pump, the venous chamber is turned upside down and the mesh of the venous chamber is taken out into the air from the blood surface, and it is visually examined whether the blood is coagulated with the mesh of the venous chamber. There is also a method. However, in this method, by stopping the blood pump, blood coagulation rapidly progresses in the dialyzer, and as a result, the blood circulating outside the body together with the dialyzer and blood circuit may have to be discarded. is there. Furthermore, in many cases, the amount of air retained in the upper part of the venous chamber is only 2 to 5 ml, so that it is often impossible to take the venous chamber mesh out of the blood surface into the air itself.

JP 2005-95230 A JP 2002-282355 A

  The present invention has been made in view of the above circumstances, and when the venous pressure rises, the blood pump is stopped, the blood side volume of the blood purifier, and the blood between the blood purifier and the venous chamber. Whether the blood in the venous chamber mesh is coagulated by backfiltering a volume of dialysate approximately equal to the total volume of the circuit and the volume of the venous chamber, replacing the blood in the venous chamber with dialysate Provided is a blood purification device that can be examined macroscopically.

The blood purification apparatus of the present invention includes a blood purification device, a blood circuit, a blood pump provided in a blood circuit upstream of the blood purification device, and a vein provided in a blood circuit downstream of the blood purification device. A blood purification apparatus comprising a chamber and a dialysate circuit, wherein the dialysate circuit is provided with a reverse filtration device, and the reverse filtration device drives the reverse filtration pump and the reverse filtration pump to provide a blood purification device. Of the blood side volume, the volume of the blood circuit between the blood purifier and the venous chamber, and the amount of backfiltration approximately equal to the total volume of the venous chamber, and the predetermined amount of backfiltration is completed. And a reverse filtration pump control means for stopping the drive of the reverse filtration pump. Here, the dialysate circuit is preferably a sealed water removal control system, and a viscous control system or a double chamber system can be adopted as the sealed water removal control system. The double-chamber method, double-pump method, and viscous control method can be used as the closed-type water removal control method. However, the double-pump method requires special means to perform reverse filtration, just like the viscous control method. Therefore, it can be handled as a device similar to the viscous control method.

When the sealed water removal control is a viscous control system, a chamber that stores fresh dialysate and supplies it to the blood purifier through the dialysate circuit, and a used one that flows from the blood purifier through the drain side of the dialyzer circuit It consists of a chamber for storing dialysate and a chamber for water removal. These three chambers are partitioned by a flexible membrane, and the chamber for water removal is filled with a liquid such as silicon oil. A viscous chamber is used in which the liquid can be freely taken in and out by a viscous pump, and the viscous pump has the function of a reverse filtration pump.
In addition, when the closed water removal control is a double chamber system, the fresh dialysate is stored and supplied to the blood purifier through the dialysate circuit, and flows from the blood purifier through the drain side of the dialyzer circuit. It consists of a chamber for storing used dialysate, and an equalizer in which these two chambers are separated by a flexible membrane is adopted. The reverse filtration pump is installed across the solution pump on the dialysate drainage side. There is a case where it is provided in a circulating circuit provided, and a case where it is provided in a reverse filtration circuit provided on the dialysate supply side of the dialysate circuit so as to straddle the equalizer.

Although the present invention has been generally described above, a better understanding can be obtained by reference to certain specific embodiments. These examples are provided herein for illustrative purposes only and are not limiting unless otherwise specified.

According to the present invention, the following effects can be expected. That is, a reverse filtration pump is driven in the dialysate circuit, and the blood side volume of the blood purifier, the volume of the blood circuit between the blood purifier and the venous chamber, and the volume of the venous chamber And a reverse filtration pump control means for stopping the drive of the reverse filtration pump when a predetermined amount of reverse filtration is completed. Therefore, when the venous pressure rises, the blood pump can be stopped, a predetermined amount of dialysate can be back-filtered, and the blood in the venous chamber can be replaced with dialysate. It can be examined visually whether it has solidified.

A blood purifier, a blood circuit, a blood pump provided in a blood circuit upstream of the blood purifier, a venous chamber provided in a blood circuit downstream of the blood purifier, and a dialysate circuit In the blood purification apparatus, a reverse filtration device is provided in the dialysate circuit, and the reverse filtration device drives the reverse filtration pump, the reverse filtration pump, and the reverse filtration pump to perform 10-30 ml of reverse filtration. And reverse filtration pump control means for stopping the reverse filtration pump when the predetermined amount of reverse filtration is completed. The dialysate circuit employs a viscous control system as a closed-type water removal control system, a room for storing fresh dialysate and supplying it to the blood purifier through the dialysate circuit, and a drain from the blood purifier to the dialysis circuit. It consists of a chamber for storing spent dialysate flowing in through the side and a chamber for water removal. These three chambers are partitioned by a flexible membrane, and the chamber for water removal contains silicone oil. A viscous chamber is used in which a liquid such as the above is filled and the liquid can be freely taken in and out by a viscous pump. The viscous pump has a function of a reverse filtration pump.

First, Example 1 will be described with reference to FIG.
FIG. 1 is a schematic explanatory view of Example 1, and shows a blood purification apparatus when a viscous control system is adopted as a sealed water removal control system.
The blood purification apparatus of Example 1 includes a blood purification device 1, a blood circuit 2, a blood pump 3 provided in a blood circuit upstream of the blood purification device 1 (arterial blood circuit 21), and a blood purification device 1. A venous chamber 23 provided in the blood circuit (venous side blood circuit 22) on the downstream side and a dialysate circuit 4 are included. The dialysate circuit 4 is provided with a viscous chamber 5 for performing sealed water removal control. It is possible. The viscous chamber 5 includes a viscous pump 61, and the reverse filtration pump control means 62 controls the driving and stopping of the viscous pump 61 having the function of a reverse filtration pump that is a component of the reverse filtration device 6, so that blood It is possible to perform reverse filtration of almost the same volume (about 20 to 80 mL) as the volume from the purifier to the venous chamber.

  The viscous chamber 5 is collected in a fresh dialysate storage chamber 51 for storing fresh dialysate supplied from a dialysate preparation device (not shown) and a drainage circuit 42 used in the blood purifier 1. A used dialysate storage chamber 52 for storing the used dialysate, and a viscous chamber 53 containing silicon oil provided between the two storage chambers 51, 52, each chamber 51, 52, 53 is partitioned by a flexible membrane. Two viscous chambers 5 are usually provided, and the dialysate can be continuously supplied by switching the viscous chambers. The viscous chambers of the two viscous chambers are connected by a single viscous pump 61. The amount of silicon oil accommodated in the viscous chamber is controlled by the viscous pump 61 so that the silicone oil can be moved from one viscous chamber to the other viscous chamber.

Next, reverse filtration for visually examining whether or not blood is coagulated with the mesh of the venous chamber 23 will be described. FIG. 3 is a flowchart of reverse filtration.
The pressure in the venous chamber 23 during blood purification treatment is measured by a pressure gauge P, and the measured pressure signal is sent to the reverse filtration pump control means 62 of the reverse filtration device 6. When the internal pressure of the venous chamber 23 rises during blood purification treatment (S1), the reverse filtration pump control means 62 that has received the pressure signal from the pressure gauge P transmits a drive stop signal to the blood pump 3 to The drive is stopped (S2), and then a drive signal is transmitted to the reverse filtration pump (viscous pump) 61 to drive the reverse filtration pump 61 (S3). When the reverse filtration of a predetermined amount (determined within the range of 20 to 80 ml, which is approximately the same volume as the blood purifier 1 to the venous chamber 23) is completed (S4), the drive of the reverse filtration pump 61 is stopped (S5). . Since the inside of the venous chamber 23 after completion of reverse filtration is filled with dialysate, blood coagulation can be confirmed with the naked eye when blood coagulation occurs in the mesh.

When blood coagulation is found in the mesh, it is necessary to return the blood in the blood circuit 1 and the blood circuit 2 and replace it with a new blood circuit. If blood coagulation is not found in the mesh, it can be determined that the tip of the venous puncture needle has adhered to the shunt tube wall, so the tip of the venous puncture needle is moved from the shunt tube wall in various ways. Try to release. If the internal pressure of the venous chamber still does not decrease, it is determined that the tip of the venous puncture needle cannot be released from the shunt tube wall, and the venous puncture needle needs to be re-punctured.
When blood coagulation is found in the mesh and blood is returned, it is necessary to add the amount of replacement fluid required for blood return to the water removal amount. A program for adding the amount of the replacement fluid to the water removal amount may be incorporated in the reverse filtration pump control means 62.

Next, Example 2 will be described with reference to FIG.
FIG. 2 is a schematic explanatory diagram of the second embodiment, and adopts a double chamber system as a sealed water removal control system, and a reverse filtration circuit in which a reverse filtration pump is provided across the equalizer on the dialysate supply side. The blood purification apparatus when it is provided in is shown.
The blood purification apparatus of Example 2 includes a blood purifier 1, a blood circuit 2, a blood pump 3 provided in an arterial blood circuit 21, a venous chamber 23 provided in a venous blood circuit 22, and a dialysate. A circuit 4 is included, and the dialysate circuit 4 is provided with an equalizer 7 to enable hermetic water removal control. The dialysate supply circuit 41 is provided with a reverse filtration circuit 81 so as to straddle the equalizer 7, and the reverse filtration circuit 81 is provided with a reverse filtration pump 82.
The reverse filtration device 6 includes the reverse filtration pump 82 and the reverse filtration pump control means 62.
The equalizer 7 is collected in a fresh dialysate storage chamber 71 for storing fresh dialysate supplied from a dialysate preparation device (not shown) and the drainage circuit 42 used in the blood purifier 1. It consists of a used dialysate storage chamber 72 for storing used dialysate, and each chamber 71, 72 is partitioned by a flexible membrane. Two equalizers 7 are usually provided, and the dialysate can be continuously supplied by switching the equalizers. Reference numeral 43 denotes a liquid feed pump for sending dialysate to the blood purifier 1.

Next, reverse filtration and recovery for macroscopically examining whether blood is coagulated at the mesh of the venous chamber 23 will be described.
When the internal pressure of the venous chamber 23 rises during blood purification treatment (S1), the reverse filtration pump control means 62 that has received the pressure signal from the pressure gauge P transmits a drive stop signal to the blood pump 3 to The drive is stopped (S2), and then a drive signal is transmitted to the reverse filtration pump 82 to drive the reverse filtration pump 82 (S3). When the reverse filtration of a predetermined amount (determined within the range of 20 to 80 ml) is completed (S4), the drive of the reverse filtration pump 82 is stopped (S5). Since the inside of the venous chamber 23 after completion of reverse filtration is filled with dialysate, blood coagulation can be confirmed with the naked eye when blood coagulation occurs in the mesh.

1 is a schematic explanatory diagram of Example 1. FIG. 6 is a schematic explanatory diagram of Example 2. FIG. It is a flowchart of reverse filtration.

1 hemodialyzer 2 blood circuit 21 arterial blood circuit 22 venous blood circuit 23 venous chamber 3 blood pump 4 dialysate circuit 41 dialysate supply circuit 42 drainage circuit 43 liquid feed pump 5 viscous chamber 51 fresh dialysate storage chamber 52 Used dialysate storage chamber 53 Viscous chamber 6 Reverse filtration device 61 Viscous pump (reverse filtration pump)
62 Reverse filtration pump control means 7 Equalizer 71 Fresh dialysate storage chamber 72 Used dialysate storage chamber 81 Reverse filtration circuit 82 Reverse filtration pump

Claims (4)

A blood purifier, a blood circuit, a blood pump provided in a blood circuit upstream of the blood purifier, a venous chamber provided in a blood circuit downstream of the blood purifier, and a dialysate circuit In the blood purification apparatus, a reverse filtration device is provided in the dialysate circuit, and the reverse filtration device drives the reverse filtration pump and the reverse filtration pump so that the blood side volume of the blood purification device and the blood purification device The back-filtration pump is driven when a predetermined amount of back-filtration is completed, and the amount of back-filtration is approximately equal to the total volume of the blood circuit between the blood vessel and the vein chamber A blood purification device comprising a reverse filtration pump control means for stopping. 2. The blood purification apparatus according to claim 1, wherein the dialysate circuit is a closed water removal control system. The sealed water removal control method is a viscous control method, a chamber that stores fresh dialysate and supplies it to the blood purifier through the dialysate circuit, and a used one that flows from the blood purifier through the drain side of the dialyzer circuit A chamber for storing dialysate and a chamber for water removal are further divided into three chambers by a flexible membrane, and the chamber for water removal is filled with a liquid such as silicon oil, The blood purification apparatus according to claim 2, wherein a viscous chamber is used in which liquid is configured to be freely inserted and removed by a viscous pump, and the back filtration pump is the viscous pump. The closed-type water removal control method is a double chamber method, a chamber that stores fresh dialysate and supplies it to the blood purifier through the dialysate circuit, and a used that flows from the blood purifier through the drain side of the dialyzer The blood purification apparatus according to claim 2, wherein the blood purification apparatus comprises a chamber for storing dialysate, and an equalizer in which the two chambers are partitioned by a flexible membrane.

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